Elderly Health Journal 2019; 5(2): 65-71 Shahid Sadoughi University of Medical Sciences, , Journal Website : http://ehj.ssu.ac.ir Original Article Comparison of Knowledge and Attitude of Health Care Providers towards Aging Phenomenon in Yazd and Hamadan, Iran

Mohammad Morowatisharifabad 1, 2, Amir Hossein Bahram 1, 2 * , Reza Bidaki 3, Seyedeh Mahdieh Namayandeh 4

1. Department of Ageing Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2. Elderly Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 3. Research Center of Addiction and Behavioral Sciences, Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 4. Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

* Corresponding Author: Department of Ageing Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Tel: +989189113826, Email address: [email protected]

A B S T R A C T

Article history Received 11 Sep 2018 Introduction: Health care providers play a central role as the main members of the health Accepted 14 Sep 2019 care service providers team for the elderly and their knowledge and attitudes towards the aging phenomenon can play an important role in the quality of health care services provision for the elderly. Therefore, the present study aims to comparatively investigate knowledge and attitude of health care providers about the aging phenomenon in comprehensive health Citation: centers of Yazd and Hamadan, Iran. Morowatisharifabad MA, Bahram AH, Methods: The cross-sectional study conducted on 220 health care providers who were Bidaki R, Namayandeh enrolled in the study from comprehensive health centers in Yazd and Hamadan by cluster SM. Comparison of sampling. The data were collected by a questionnaire including demographic information, knowledge and attitude Kogan's attitude towards old people scale, and Palmore Facts on Aging Quiz. Data were of health care providers analyzed by SPSS using descriptive statistics, independent t-test, ANOVA, and Pearson towards aging correlation coefficient. phenomenon in Yazd and Hamadan, Iran. Results: Mean score of knowledge about aging (range: 0-25) was 12.24 ± 2.43 in Yazd and Elderly Health Journal. 12.17 ± 2.51 in Hamadan. Mean score of attitude towards aging (range: 34-204) was 121.49 2019; 5(2): 65-71 ± 10.53 in Yazd and 119.40 ± 11.21 in Hamadan. There was no statistically significant difference in knowledge (p = 0.828) and its three dimensions (misconceptions about aging, Downloaded from ehj.ssu.ac.ir at 2:47 IRST on Wednesday January 8th 2020 [ DOI: 10.18502/ehj.v5i2.2151 ] psychosocial status and physical condition), and attitude (p = 0.152) and its three levels (negative, neutral and positive attitude) between health care providers in Yazd and Hamadan. There was a significant, positive correlation between knowledge and attitude in both Yazd (p < 0.01, r = 0.656) and Hamadan (p < 0.01, r = 0.718).

Conclusion: The knowledge of health care providers in both cities was moderate and had positive attitude towards aging. Considering the moderate knowledge of health care providers about the aging, effective steps can be taken to promote knowledge and improve the attitudes of health care providers by providing educational curricula on physical, psychological, social and spiritual health of the elderly people and holding in-service training programs.

Keywords: Knowledge, Attitude, Aging, Health Personnel

Copyright © 2019 Elderly Health Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cite. Knowledge and Attitude of Health Care Providers towards Aging

Introduction Methods Study design and participants Receiving about 70% of hospital services, elderly also account for approximately 80% of home care visits, 90% This cross-sectional study was conducted on health care of sanatoria’s residents and 85% of hospitalized patients in providers in comprehensive health care centers in Yazd the wards of chronic diseases (1), which imposes and Hamadan cities in Iran. The required sample size was stupendous costs on health system, because elderly care is estimated to be 220, and participants were selected by costly and increases the burden of diseases in the whole cluster sampling. For this purpose, 10 comprehensive society (2, 3). health care centers were randomly selected from each city Besides, the need for specialized workforces to care for as clusters, and from each cluster, 11 health care providers the elderly in hospitals, long-term health care providing were randomly selected, 110 of whom were included in institutes, and society is considered one of the main the study. challenges facing the health system (4). The use of low- experienced and untrained caregivers to care for the elderly Instruments leads to a decrease in the quality of care for the elderly, and The data was collected using a questionnaire therefore an increase in recovery time and understandable consisting of three sections: complications (5). Demographic information including gender, age, Lack of knowledge about the natural physiological education, marital status, employment status, works changes in aging causes failure in provision of care experience, and living with the elderly relatives at home. proportionate to natural, age-related changes, which can The Kogan Attitudes towards Old People Scale (KAOP): put older people at serious risk. (6) KAOP was developed by Kogan in 1961 to assess the Besides, caregivers’ insufficient knowledge and attitudes of nurses towards the elderly (14). This negative attitudes affect their performance adversely and instrument is a 34-item scale, consisting of 17 items on make them unable to provide necessary care for the elderly positive attitudes and 17 items on negative attitudes that (6). The study of Mellor et al. (6) in Australia showed that investigate the respondent's attitudes towards aging. The despite the fact that nurses had a positive attitude towards items are rated on a 6-point Likert scale ranging from the elderly, they had comparatively lower levels of Absolutely Disagree (scored 1) to Absolutely Agree knowledge about aging, especially natural physiological (scored 6). The items on negative attitudes are inversely changes in aging. scored to obtain the respondent's total score on attitudes In the study of Rathnayake et al. (7), students' attitudes (15), which ranges from 34 to 204. The score 102 towards the elderly were positive; however, they showed represents neutral attitude towards aging and lower and little interest in working with the elderly. In the study of higher scores than 102 represent negative and positive Asayesh et al. (8), half of the general practitioners had a attitudes, respectively (8). The KAOP has been widely positive attitude towards the elderly, and it was used to assess health care professionals’ attitudes towards recommended that plans be designed to improve their aging (10, 16). The reliability of the KAOP has been attitudes towards the elderly. confirmed in some studies (15, 17, 18). Validity and In the study of Ravanipour et al. (9), nurses’ knowledge reliability of the Persian version of this instrument was about the facts of aging was reported to be moderate. studied by Reje et al. (19) in 2014. The content validity Some studies have shown that the quality of care provided of this instrument was reported 0.95 that indicates its by health care professionals is influenced by their attitudes acceptable content validity. Its reliability was also drawn (10, 11). 0.83 using Cranach's alpha coefficient. According to the More than 9% of Iran population is elderly and is results, this scale can be used as a valid instrument to expected to reach over 30% by 2050 (12). Although the investigate attitudes towards aging in Iran. elderly population has not yet been manifested as an urgent The Palmore's Facts on aging quiz (FAQI): The issue due to the predominantly young demographic FAQI was developed by Pal more in 1966 (20), has structure of the country, in the coming years, the health 25 items and three dimensions: knowledge about system will be heavily involved with it, and it is necessary misconceptions about aging (10 items), physical that a comprehensive planning be performed for effective Downloaded from ehj.ssu.ac.ir at 2:47 IRST on Wednesday January 8th 2020 [ DOI: 10.18502/ehj.v5i2.2151 ] condition (5 items) and psychosocial status (10 dealing with the aging phenomenon from now. This items). The minimum and maximum possible scores planning requires an accurate understanding of the status on the FAQI are 0 and 25, respectively. The items of the elderly people in Iran and the needs of this are four-choice questions, and each item is scored 1 population (13). if answered correctly and 0 if answered wrongly. Given the importance of providing first-level, preventive The scores are classified as follows: scores 0-8 integrated services in the aging period, the key role of represent low knowledge, 9-17 moderate knowledge, health care providers as the first level of contact between and above 17 high knowledge (9). Validity and the elderly people and the primary health care system, and reliability of the Persian version of this instrument the effect of knowledge and attitude towards the aging on was also studied by Reje et al. (21) in 2014, where the professional behavior of health care providers and lack the Cronbach's alpha coefficient was drawn 0.81 of studies on this subject, this study will comparatively indicating a high internal consistency, and its investigate the knowledge and attitude of health care correlation coefficient was calculated at 0.98 providers towards the aging phenomenon in showing an acceptable test-retest reliability. comprehensive health centers in Yazd and Hamadan cities in Iran.

66 Elderly Health Journal 2019; 5(2): 65-71. Morowatisharifabad et al.

Data analysis significant difference between the two groups in demographic variables (p > 0.05). Demographic variables The data were analyzed by the SPSS. Descriptive of participants are shown in table 1. statistics including frequency, mean and standard The mean score on knowledge of health care providers deviation were used to describe the data; t-test was in Yazd was 12.24 ± 2.43 (range; 7-19) and in Hamadan used to compare the mean scores on knowledge and was 12.7 ± 2.51 (range; 7-17). There was no statistically attitude as well as binomial variables between the significant difference in the mean score on knowledge health care providers from the two cities, and analysis between the participants from the two cities. of variance to compare the mean scores on knowledge There was also no significant difference in the three and attitude with respect to multinomial variables. To dimensions of knowledge (misconceptions about the investigate the correlation between knowledge and aging, psychosocial status, and physical condition) attitude as well as their correlation with quantitative between the health care providers of the two cities (p > demographic variables, Pearson correlation coefficient 0.05). (Table 2) was used. The highest frequency of knowledge level in both cities Ethical considerations was obtained for moderate level (90.9% in Yazd and 87.3% in Hamadan). While 1.8% of health care providers The study protocol was approved by the Ethics from Yazd had a high level of knowledge, and none of the Committee of Shahid Sadoughi University of Medical health care providers from Hamadan had a high level of Sciences (Code of Ethics: IR.SSU.SPH.REC.1396.84). knowledge. Participation in the study was informed and voluntary, There was no significant difference in knowledge and its and the participants were ensured that their information levels between health care providers from Yazd and would be kept confidential. Hamadan (p > 0.05). (Table 3) The mean scores of attitudes in health care providers from Results Yazd and Hamadan were 121.49 ± 10.51 and 119.40 ± 11.21, respectively. There was no significant difference in attitude and The mean age of health care providers from Yazd was its levels (negative, neutral, and positive) between the 30.5 ± 4.2 years and from Hamadan was 33.5 ± 5.3 years; participants from the two cities (p > 0.05) (Table 4) and 70.9% of health care providers from Yazd and 76.3% of those from Hamadan were female. There was no

Table 1. Frequency of demographic variables in health care providers of comprehensive health centers in Yazd and Hamadan Demographic variable Yazd Hamadan p -value N % N % Gender Male 32 1.29 26 6.23 Female 78 9.70 84 3.76 0.356 Education Bachelor and less 94 5.85 100 9.90 Masters and higher 16 5.14 10 1.9 0.203 Marital status Single 36 32.7 28 25.5 Married 74 67.2 82 74.5 0.085 Employment status Official 38 5.34 43 39 Pledge 15 6.13 19 2.17 Contractual 13 8.11 10 9 0.545 Company 40 3.36 31 1.28 Plan 4 6.3 7 3.6 Work experience 0-10 79 8.71 68 8.61 11-20 31 1.28 42 1.38 0.911 Downloaded from ehj.ssu.ac.ir at 2:47 IRST on Wednesday January 8th 2020 [ DOI: 10.18502/ehj.v5i2.2151 ] >20 0 0 0 0 Living with older Yes 36 7.32 43 1.39 0.081 people at home No 74 2.67 67 9.60

Table 2. Distribution of knowledge score about aging and its dimensions among health care providers of comprehensive health centers in Yazd and Hamadan Variable Yazd Hamadan Mean SD Range of Mean SD Range of p-value scores scores Knowledge score 12.24 2.43 7-19 12.7 2.51 7-17 0.82 Misconceptions about the 3.4 1.4 0-7 3.57 1.42 0-7 0.14 aging dimension Psychosocial dimension 5.12 1.41 2-9 5.11 1.58 2-9 0.29 Physical dimension 3.72 0.9 1-5 3.48 0.91 1-5 0.65

Elderly Health Journal 2019; 5(2): 65-71. 67 Morowatisharifabad et al.

Table 3. Frequency of knowledge levels about aging in the health care providers from comprehensive health care centers in Yazd and Hamadan Knowledge Level Yazd Hamadan p-value N % N % Low 8 7.3 14 12.7 0.45 Moderate 100 90.9 96 87.3 0.28 High 2 1.8 0 0 0.67

Table 4. Frequency of attitude towards aging in health care providers of comprehensive health care centers in Yazd and Hamadan Yazd Hamadan p -value N % Mean ± SD N % Mean ± SD Attitude score 121.49 ± 10.53 119.40 ± 11.21 0.152 Negative 9 8.2 97 ± 2.06 13 11.8 96 ± 3 0.488 Levels of attitude Neutral 1 0.9 102 2 1.8 102 297.0 Positive 100 90.9 7 ± 123 95 4.86 ± 1227 654.0

The correlation between knowledge and attitude bachelor's degree and lower education levels was positive and significant in both cities (Yazd: r (118.38 ± 11.16). There was no significant = 0.656, p < 0.01; Hamadan: r = 0.718, p < 0.01). relationship between the mean score of attitude and There was no significant relationship between other demographic variables (Table 5). knowledge about aging and age in health care providers in both cities (p > 0.05). However, there Discussion was a positive correlation between age and attitude in health care providers in Hamadan (p < 0.05, r = The aim of this study was to comparatively investigate 0.229). the knowledge and attitude of health care providers In health care providers in Yazd, the mean score towards the aging phenomenon in comprehensive health of knowledge was significantly different by care centers of Yazd and Hamadan. The results of the education level, so that the mean of knowledge in study showed that the mean score of knowledge about health care providers with master's degree and aging in health care providers in both cities was moderate, higher education levels (13.81 ± 2.63) was higher which suggests that health care providers in both cities than those with bachelor's degree and lower answered almost half of the items of the FAQI correctly. education levels (11.97 ± 2.30) (p = 0.005). There Only 1.8% of health care providers in Yazd had a high was also a significant difference in the mean score level of knowledge, while none of the health care of knowledge in terms of living with the elderly providers from Hamadan had a high level of knowledge; relatives at home, so that the health care providers finally, the mean levels of knowledge and its three who lived with the elderly relatives at home (12.38 dimensions were not significantly different between the ± 2.95) had higher knowledge than those who did health care providers from the two cities. not (11.97 ± 1.83) (p = 0.035). There was no Ravanipour et al. (9) reported the mean score of significant association between knowledge and knowledge to be moderate, while none of the participants other demographic variables of health care had a high level of knowledge. Besides that, in the studies providers from Yazd. of Mellor et al. (6) and Liu et al. (22), knowledge level was In health care providers from Hamadan, the reported to be moderate, which is consistent with our

Downloaded from ehj.ssu.ac.ir at 2:47 IRST on Wednesday January 8th 2020 [ DOI: 10.18502/ehj.v5i2.2151 ] mean score of knowledge was significantly study. In the study of Forouzandeh et al. (23) to investigate different in terms of living with the elderly the relationship of knowledge about the facts of aging and relatives, so that the health care providers who attitude with occupational stress in the registered lived with the elderly relatives at home (12.86 ± caregivers of sanatoria in , the knowledge score was 2.38) had higher knowledge than those who did not low, which could be due to the non-academic education (11.73 ± 2.51) (p = 0.021). among most caregivers in the sanatoria. Other studies have Knowledge was not significantly associated with also shown lack of knowledge about elderly care in nurses other demographic variables, but the mean score of (13, 24). attitude was significantly different in terms of The highest number of correct answers given by health education level (p = 0.003), so that the mean score care providers in both cities was obtained for the physical of attitude was significantly higher in health care dimension. The studies of Reje et al. (21) and Ravanipour providers with master's degree and higher et al. (9) also suggested that the highest number of correct education levels (129.40 ± 5.56) than in those with answers on knowledge was obtained for this dimension.

Elderly Health Journal 2019; 5(2): 65-71. 68 Knowledge and Attitude of Health Care Providers towards Aging

Table 5. Mean and SD of knowledge and attitude towards aging scores by demographic variables in health care providers in Yazd and Hamadan

Variable Yazd Hamadan Mean (SD) score of p -value Mean (SD) p -value Mean (SD) score p -value Mean (SD) score p -value knowledge score of attitude of knowledge of attitude Gender Male 12.62 (2.68) 0.297 120.69(11.02) 0.611 11.78 (2.54) 0.296 118.24 (11.21) 0.488 Female 12.08 (2.32) 121.82 (10.38) 12.33 (2.50) 119.87 (11.25) Marital status Married 12.16 (2.50) 0.726 121.41 (10.84) 0.943 12.10 (2.35) 0.655 119.19 (10.91) 0.767 Single 12.32 (2.38) 121.56 (10.31) 12.35(2.97) 119.92 (12.24) Education Bachelor and less 11.97 (2.30) 0.005 120.80 (10.44) 0.100 12.04 (2.47) 0.080 118.38 (11.15) 0.003 Masters and higher 13.81 (2.63) 125.50 (10.48) 13.50 (2.63) 129.40 (5.56) Employment status Official 12.37 (2.31) 0.924 121.26 (10.45) 0.253 11.83 (2.74) 0.916 118.89 (11.39) 0.906 Pledge 12.26 (2.56) 123.87 (9.32) 12.23 (2.43) 119.96 (10.33) Contractual 12.13 (2.56) 121.87 (9.32) 12.52 (2.53) 119.08 (12.61) Company 11.94 (2.30) 117 (12.05) 11.93 (2.40) 121.37 (11.68) Plan 12.21 (2.54) 120.56 (11.86) 12.08 (2.84) 117.16 (11.45) Work experience 0-10 12.12 (2.36) 0.242 121.07 (10.27) 0.369 12.13 (2.49) 0.763 118.47 (10.99) 0.091 11-20 12.84 (2.73) 123.74 (11.78) 12.31 (2.66) 123 (11.60) Living with elderly relatives at Yes 12.38 (2.95) 0.035 119.54 (11.52) 0.088 12.86 (2.38) 0.021 118.23 (11.19) 0.392 home No 11.79 (1.83) 123 (9.52) 11.73 (2.51) 120.11 (11.24)

69 Elderly Health Journal 2019; 5(2): 65-71. Downloaded from ehj.ssu.ac.ir at 2:47 IRST on Wednesday January 8th 2020 [ DOI: 10.18502/ehj.v5i2.2151 ] Morowatisharifabad et al.

There was no significant relationship between In health care providers in Hamadan, the average knowledge and age, gender, marital status and work attitude of health care providers with master's degree and experience in the health care providers in both cities. In the higher education levels was higher than that of those with studies of Mellor et al. (6), Askarzadeh et al. (13) Tabiei bachelor's degree or lower education levels. In the study of and et al. (24), there was no significant relationship Rathnayake et al. (7), there was no significant relationship between knowledge and any of the demographic between attitude and education, which is not consistent characteristics, as well. However, in the study of with our study. This inconsistency could be due to the fact Ravanipour et al. (9), there was a significant relationship that our participants were employed, but the participants in between knowledge and age, which could be due to the the study of Rathnayake et al. (7) were freshman to senior high similarity of our participants to that study's nursing students. participants. Besides that, in the study of Reje et al. (21), There was a positive and significant correlation between nurses with more work experience attained a higher score knowledge and attitude of health care providers in both on all dimensions and the total questionnaire. The reason cities. In the study of Forouzandeh et al. (23), there was a for this could be comparatively higher work experience of positive and significant correlation between knowledge nurses in hospitals than that of health care providers in and attitude towards aging, i.e., if knowledge about aging comprehensive health care centers. increased, the attitudes towards the elderly were also Mean score of knowledge in health care providers in improved. In the study of Askarzadeh et al. (13), there was both Yazd and Hamadan was significantly different in no correlation between knowledge and attitude, which is terms of living with the elderly, so that in both cities not consistent with our study. This is probably due to knowledge was higher in health care providers who lived different types of questionnaires used in two studies. with the elderly at home than in those who did not. In the There was no significant difference in the mean levels of study of Reje et al. (21), nurses who had an elderly person knowledge and attitudes between the health care providers in the family and had an elderly care experience in the of comprehensive health care centers in Yazd and family attained higher scores on all dimensions and the Hamadan, which is due to the same education curriculum total questionnaire. In the study of Lambrinou et al. (16), that are developed for health care providers in schools of there was a significant relationship between taking care of public health and the same training courses in the health the elderly in the past and the level of knowledge about departments of medical universities across Iran. aging, which is consistent with the results of our study. Therefore, it can be argued that family members' Conclusion knowledge about the aging increases due to the presence of the elderly at home. The knowledge levels of health care providers regarding Despite the cultural and ethnic differences between aging in both cities were moderate, and both groups of Yazd and Hamadan, there was no significant difference health care providers had positive attitudes towards the in the attitude toward the aging between the health care elderly. There was a significant correlation between providers of the two cities, and the mean scores of knowledge and attitude, so that with the increase in attitude toward the aging in the health care providers of knowledge, the attitude would become more positive. the two cities were positive. Asayesh et al. (8) also It is recommended that an effective step be taken to investigated the attitudes of general practitioners toward promote knowledge and improve the attitudes of health aging, where half of the general practitioners had a care providers by providing educational curricula on positive attitude toward aging and no significant physical, psychological, social and spiritual health of the difference in attitude toward aging was observed among elderly people in studies programs and holding in-service the general practitioners from different ethnicities. In the training programs. studies of Erdemir et al. (15) and Rathnayake et al. (7), the mean attitude score was also reported to be positive, but in the study of Celik et al. (25) on a group of nursing Study limitations students in , most students had a negative attitude The majority of health care providers participating in toward aging, and 83% of students said they were having this study were women, according to the gender proportion Downloaded from ehj.ssu.ac.ir at 2:47 IRST on Wednesday January 8th 2020 [ DOI: 10.18502/ehj.v5i2.2151 ] difficulty working with the elderly patients. In addition, of health care providers working in comprehensive health the study of Boduroglu et al. (26) to compare attitudes care centers. This is one of the points that should be taken toward aging in Chinese and American communities into consideration in using the results. showed that the attitudes of the two communities were similar, and both groups had a low-level attitude. Differences in attitudes toward aging between Iran and Conflicts of interest other societies can be due to the transcendent cultural The authors declare no conflicts of interest. values and traditional and religious beliefs about respect for the elderly in Iranian society. There was no significant relationship between attitude Acknowledgements toward aging and gender, marital status, work The present article was derived from a thesis to award experience, employment status and the presence of older master's degree on aging health at School of Public Health, people at home in health care providers from Yazd and Shahid Sadoughi University of Medical Sciences, Yazd. Hamadan. The authors thank the health care providers who participated in the study.

Elderly Health Journal 2019; 5(2): 65-71. 70 Knowledge and Attitude of Health Care Providers towards Aging

Authors ' contribution https://www.amar.org.ir/english/Iran-Statistical Yearbook/ Statistical-Yearbook-2016-2017 All the authors contributed in designing the study, 13. Askarzadeh mahany M, Arab M, Alizadeh M, analyzing and interpreting the data and preparing the Haghdust A. Nurses' knowledge about aging and attitudes manuscript. Data collection carried out by AHB. All the toward older people. Iran Journal Of Nursing. 2008; authors have read and approved the final manuscript. 21(55): 19-27. [Persian] 14. Kogan N. Attitudes toward old people in an older References sample. Journal of Abnormal and Social Psychology. 1961; 62(3): 616-22. 1. Forooghan M, Amanian D, Hosseini MA. The 15. Erdemir F, Kav S, Citak E, Hanoglu Z, Karahan A. A effect of the training program about management Turkish version of Kogan’s attitude toward older people of elders’ common problems on the level of job (KAOP) scale: reliability and validity assessment. stress in caregivers of nursing homes. Journal of Archives of Gerontology and Geriatrics. 2011; 52(3): 162- Research Development in Nursing and 5. Midwifery. 2013; 10(2): 54-62. [Persian] 16. Lambrinou E, Sourtzi P, Kalokerinou A, Lemonidou 2. Gharanjik A, Mohammadi Shahbolaghi F, C. Attitudes and knowledge of the Greek nursing students Ansari G, Najafi F, Ghaderi S, Ashrafi K, et al. towards older people. Nurse Education Today. 2009; The prevalence of depression in older Turkmen 29(6): 617-22. adults in 2010. Salmand Iranian Journal of 17. Ghorbani A, Karimzadeh T, Azadmanesh Y. Ageing. 2011; 6(3): 34-9. [Persian] Nutritional assessment in elderly hospitalized patients in 3. Fakhrzadeh H, Sharifi F. Cardiovascular teaching hospitals in 2011. Salmand Iranian diseases in the elderly. Journal of Journal of Ageing. 2013; 8(1): 33-40. [Persian] University of Medical Sciences. 2012; 14(3):1-9. 18. Ryan A, Melby V, Mitchell L. An evaluation of the [Persian] effectiveness of an educational and experimental 4. Adkins DM, Mayhew SL, Gavaza P, Rahman intervention on nursing students’ attitudes towards older S. Pharmacy students’ attitudes toward geriatric people. International Journal of Older People Nursing. nursing home patients. American Journal of 2007; 2(2): 93-101. Pharmaceutical Education. 2012; 76(5): 1-6. 19. Reje N, Heravi-Karimooi M, Montazeri A, Foroughan 5. Purfarzad Z, Ghamari zadre Z, Farmahini farahani M, M, Vaismoradi M. Psychometric properties of the Iranian Ghorbani M. Teachers and student nurses’ attitudes version of the Kogan's Attitudes Toward Older People towards caring for older adults in Arak, 2012. Journal of Scale. Japan Journal of Nursing Science. 2012; 9(2): 216- Clinical Nursing and Midwifery. 2014; 3(2): 46-56. 22. [Persian] 20. Palmore E. Facts on aging: a short quiz. The 6. Mellor P, Chew D, Greenhill J. Nurses’attitudes Gerontologist. 1977; 17(4): 315-20. toward elderly people and knowledge of gerontic care in a 21. Reje N, Heravi Karimooi M, Montazeri A, forooghan multi-purpose health service(MPHS). The Australian M. Psychometric of persion version questionnaire of Journal of Advanced Nursing. 2007; 24(4): 37-41. knowledge about facts of aging(FAQI). Paiesh Journal. 7. Rathnayake S, Athukorala Y, Siop S. Attitudes toward 2011; 2(11): 246-51. [Persian] and willingness to work with older people among 22. Liu Z, Pu L, Wang H, Hu X. Survey of attitude undergraduate nursing students in a public university in Sri towards and understanding of the elderly amongst Chinese Lanka: A cross sectional study. Nurse Education Today. undergraduate medical students. Asian Biomedicine. 2014; 2016; 36: 439-44. 8(5): 615-22. 8. Asayesh H, Qorbani M, Parvaresh Masoud M, 23. Forouzandeh S, Foroughan M, Hosseini MA, Farhadi Rahmani Anarki H, Ansari H, Mansourian M, et al. A, Biglarian A. The relationship of nursing home General practitioner attitude toward elders: using Kogan's caregivers’ awareness and attitude towards elderlies with attitudes questionnaire. Iranian Journal of Diabetes and their job. Journal of North Khorasan University of Medical Metabolism. 2014; 13(6): 479-86. [Persian] Sciences. 2018; 9(3): 445-52. [Persian] Downloaded from ehj.ssu.ac.ir at 2:47 IRST on Wednesday January 8th 2020 [ DOI: 10.18502/ehj.v5i2.2151 ] 9. Ravanipour M, Dadaeen A, Jahanpour F, Husseini S. 24. Tabiei Sh, Saadatjoo SA, Hoseinian SZ, Naseri MS, Measuring nurses' knowledge about the facts of aging Eisanejad L, Ghotbi M, et al. Nurses` knowledge and period in educational hospitals of in 2012. Journal attitude towards care delivery to the aged with of Geriatric Nursing. 2015; 1(2): 55-67. [Persian] cardiovascular diseases. Modern Care Journal (Scientific 10. Bleijenberg N. Dutch nursing students’ knowledge and Quarterly of Nursing & Midwifery Faculty). 2010; attitudes towards older people- a longitudinal cohort study. 7(3): 41-7. [Persian] Journal of Nursing Education and Practice. 2012; 2(2): 1- 25. Celik SS, Kapucu S, Tuna Z, Akkus A. Views and 8. attitudes of nursing students towards ageing and older 11. Hanson RM. 'Is elderly care affected by nurse patients. Australian Journal of Advanced Nursing. 2010; attitudes?' A systematic review. British Journal of Nursing. 27(4): 24-30. 2014; 23(4): 225-9. 26. Boduroglu A, Yoon C, Luo T, Park DC. Age-related 12. Statistical Centre of Iran. Statistical Yearbook of the stereotypes: A comparison of American and Chinese Islamic Republic of Iran 2016 [Internet]. Iran: Statistical cultures. Gerontology. 2006; 52(5): 324-33. Center of Iran: 2017. Available from:

71 Elderly Health Journal 2019; 5(2): 65-71.